burn
Introduction
Introduction to burns Burns generally refer to tissue damage caused by heat (including hydrothermal fluids, steam, hot gases, flames, electrical energy, chemicals, radiation, hot metal liquids or solids, etc.). It mainly refers to the damage of the skin or mucous membrane. In severe cases, it can also damage other tissues. It is also called the burn caused by the thermal damage caused by hydrothermal fluid and steam. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: shock sepsis respiratory failure acute renal failure
Cause
Cause of burn
High temperature (30%):
Most people think that high temperature is the only cause of burns. However, certain chemicals and currents can also cause burns. The skin is often only a part of the body burns. The subcutaneous tissue may also be burned. Even when there is no skin burn, there may be Internal organ burns, for example, drinking very hot liquids or corrosive substances (such as acid) can burn the esophagus and stomach. In building fires, inhaling smoke or hot air may cause lung burns.
Burned tissue may be necrotic. When tissue burns, fluid exudation in the blood vessels causes tissue edema. When extensive burns, abnormal vascular permeability, loss of large amounts of fluid may cause shock, shock, low blood pressure, flow to the brain and other Reduced blood flow to vital organs.
Electric burn (30%):
It is caused by the high temperature above 5000 °C when the current flows through the body. Sometimes it is called arc burn. When the current enters the body, the skin is often completely destroyed and burnt, because the skin resistance of the contacted charged body is very high, a large amount The electrical energy is converted into heat to burn the surface. Most electric burns also damage the subcutaneous tissue. The extent and depth of the burn varies. The range of impact may be much larger than the area of the burned skin. Severe electroconvulsive apnea may cause apnea. Arrhythmia, causing dangerous heart rate disorders.
Chemical burns (30%):
It can be caused by a variety of irritating and toxic chemicals, including strong acids, strong bases, phenols, toluene (organic solvents), mustard gas, phosphorus, etc. Chemical burns can cause tissue necrosis and slowly spread a few hours after burns.
Pathogenesis
The pathogenesis of thermal injury includes a variety of simultaneous pathophysiological processes, such as cell protein denaturation and coagulation and enzyme inactivation, prostaglandins, kinins, serotonin, histamine, oxy, lipid peroxygen, etc. The release of the mediator leads to increased capillary permeability and edema, extensive burns impair phagocytosis of phagocytic cells and T cell immunity, causing immunosuppression, and a reduction in blood supply can lead to relative hypoxia and shock.
Prevention
Burn prevention
Burn is one of the more common traumas in fire. It not only causes skin damage, but also deepens into musculoskeletal. In severe cases, it can cause a series of systemic changes, such as shock, infection, etc., whether the first aid on the spot is correct and timely, escort Whether the method and timing are appropriate is directly related to the safety of the wounded. Therefore, the injury should be quickly removed from the source of injury and necessary emergency treatment. This is the basic principle of on-site rescue.
First, quickly eliminate the source of injury
Burns in fire fighting operations generally include: flame burns; liquid, gas, solid and other high temperature burns; chemical burns; electric burns, etc. Any injury from contact with the human body to damage, there is a process, only the length of time is different Therefore, on-site rescue must strive for time, the common methods are as follows:
1. When the clothes are on fire, they should be taken off quickly; or they should be crushed and pressed down on the ground, or use various objects to cover the fire. The most effective way is to use a lot of water to extinguish the fire. Avoid standing and shouting or running for help, to prevent head and face. The respiratory tract inhales the flame damage.
2, when the gas, solid burns, should quickly leave the wounded environment.
3. When chemical substances come into contact with the skin (usually acid, alkali, phosphorus, etc.), the damage effect is directly proportional to the concentration and duration of action of these chemicals, so the clothes soaked with chemical substances should be quickly added after the injury. Remove and rinse with plenty of water to dilute and remove chemicals from the wound. Phosphorus burns should quickly remove the phosphorus-stained clothes and rinse the wound with plenty of water, or soak the wound in water to isolate the air and wash away the phosphorus particles, such as Without a large amount of water washing, the wound can be wrapped with a plurality of layers of wet cloth to prevent the phosphorus from being separated from the air to prevent the phosphorus from continuing to burn and aggravate the damage, and the oily dressing is prohibited from being wrapped to avoid increasing the dissolution and absorption of phosphorus.
4. When the electric shock occurs, immediately turn off the power, transfer the injured person to the ventilated place, loosen the clothes, check the mouth-to-mouth artificial respiration when the breathing stops, and perform the chest compression when the heart stops beating, and the respiratory heart stops. Perform artificial respiration and chest compressions, and promptly send them to nearby hospitals for further rescue.
Second, on-site simple medical first aid
1. If it is wet or burned with cold water or ice water immediately after being burned by heat, it can reduce the depth of burn wounds and have obvious analgesic effect. In cold environment, it is necessary to pay attention to the warmth and antifreeze of the wounded and sick.
2, regardless of the reasons for burns combined with other injuries, such as serious car accidents, burns at the same time combined with fractures, brain trauma, pneumothorax or abdominal organ injury, should be based on the principle of trauma first aid for emergency treatment, such as the use of first aid kit Fill and bandage open pneumothorax, stop major bleeding, simply fix the fracture, etc., and then send it to a nearby hospital for treatment.
3. After the injured person leaves the accident site, he should pay attention to the protection of burn wounds to prevent re-contamination. In addition, the wounds are generally not coated with colored drugs (such as red mercury, purple syrup, etc.), so as not to affect the judgment and clearing of the depth of burn wounds in subsequent treatment. Invasive, blister for shallow burns is generally not removed, and large blisters are only used for low-level shearing and drainage, retaining the integrity of the blister and protecting the wound.
4. After the burn, the wounded and sick have more degrees of pain and agitation, and should be given appropriate sedation and pain relief.
5, burn patients within 2 days after injury, due to increased capillary oozing, resulting in insufficient blood volume, more than half of the burn area of patients should be treated immediately, because shock will occur soon, unconditional infusion therapy should be oral Salt drinks, should not simply drink a lot of boiled water to avoid water poisoning.
6. In case of severe burns, report to the health authorities immediately and request reinforcements.
Complication
Burn complications Complications, shock, sepsis, respiratory failure, acute renal failure
Severe burns: can affect the body tissues and organs, a series of pathophysiological processes, such as water and salt electrolyte disorders, acid-base balance disorders, shock, DIC, immune imbalance, secondary infection, cardiac insufficiency, respiratory insufficiency, etc., especially Impaired respiratory function is one of the important causes of death.
1, shock
Most of the early stage is hypovolemic shock, and then concurrent infection, septic shock can occur, especially heavy burns due to strong damage stimulation, can immediately concurrent shock.
2, sepsis
Burns cause defects in the skin's barrier to bacteria; heavier patients also have weakened white blood cell function and immune function, so it is prone to infection, pathogenic bacteria are common bacteria of the skin (such as Staphylococcus aureus, etc.) or foreign sources. Sexually contaminated bacteria (such as Pseudomonas aeruginosa), suppurative infections can occur on the wound and under the eschar, infection may also develop into sepsis, septic shock, in addition, after the use of broad-spectrum antibiotics, especially in A patient with a weakened system can have a secondary fungal infection.
3. Pulmonary infection and acute respiratory failure
There may be multiple causes of pulmonary infection, such as respiratory mucosal burns, pulmonary edema, atelectasis, sepsis, etc. Adult respiratory distress syndrome or pulmonary infarction may also occur, leading to acute respiratory failure.
4, acute renal failure
Renal ischemia occurs before and after shock, and the renal capsule and renal tubules deteriorate when severe; hemoglobin, myoglobin, and toxins can damage the kidney, which can lead to acute renal failure.
5, stress ulcers and gastric dilatation
Burns of the duodenal mucosa after burns, ulcers, hemorrhage, etc., called Curling ulcers, may be related to the gastrointestinal tract once ischemia, reperfusion of hydrogen ions countercurrent damage to the mucosa, gastric dilatation is often the early gastric motility weakened patients Thirsty drinking a lot of water.
6, other
Myocardial function is reduced, stroke volume can be reduced, and it is related to myocardial inhibitory factor, infection toxin or myocardial hypoxia after burn. Brain edema or liver necrosis is also related to hypoxia, infection and so on. It is worth noting that the death of burn is often Caused by multiple system organ failure.
Symptom
Burns Symptoms Common symptoms of severe pain Burn wounds are yellowish... Burn wounds are sweet and suffocating... After nausea and vomiting after burns, pulse rate increases burn wounds light coffee... Burn wounds dark ash or... Reduced urine volume after burns Capillary leak syndrome thirst after burn
At present, the three-degree and four-point method is widely used in China. According to the depth of burn, it is divided into I degree, shallow II degree, deep II degree, III degree, clinical degree is called I degree, shallow second degree is shallow burn, deep II degree, III degree. For deep burns.
I degree burn
Injury to the superficial epidermis, basal layer still exists, local skin redness, swelling, pain, burning sensation, no blister, 3 to 5 days of healing, no scar after the healing, there may be temporary pigmentation.
Shallow second degree burn
Involved in the epidermis and dermal papillary layer, local redness, more exudate and formation of blister of different sizes, wound surface moist, fresh red, edema, severe pain; if no infection can be cured within 2 weeks, no scar formation, may have Temporary pigmentation.
Deep second degree burn
Involved in the reticular layer of the dermis, but still some dermis and skin attachments, local swelling, white or brownish yellow, small blisters, slow feeling, slightly lower skin temperature, less pain, can heal within 3 to 4 weeks without infection The scar remains after the healing, but the skin function is basically preserved.
Third degree burn
Involved in the whole layer of skin even subcutaneous fat, muscles, internal organs, pale or coke-burning, no pain, no blistering, feeling disappeared, texture and toughness like leather, after 3 to 4 weeks, the granulation tissue remains after the eschar has fallen off. Left scars, loss of skin function, causing deformity, acid burns generally do not blister, rapid sputum, sulfuric acid, nitric acid and hydrochloric acid burn sputum are dark brown, yellow brown and yellow, respectively; the deeper the burn, the darker the ochre, suede The more obvious the invagination, the harder the texture, the alkali burn wound is sticky or soapy, the color is red, there are small blisters, generally deep, the eschar or necrotic tissue falls off, the wound is sunken, the edge sneak, and the long time is not cured. In addition, acid burns are easy to estimate, and alkali burns and other chemical burns continue to deepen. The depth should be verified repeatedly.
Severe burns:
Can affect the body tissues and organs, a series of pathophysiological processes, such as water and salt electrolyte disorders, acid-base balance disorders, shock, DIC, immune imbalance, secondary infection, cardiac insufficiency, respiratory insufficiency, etc., especially respiratory function Loss is one of the important reasons for death.
According to the history of burns and skin lesions can be diagnosed, according to no water blister, only red, swollen, pain, burning sensation, edema, blister, exudate, involving the depth of skin burns.
TCM pathogenesis and syndrome differentiation:
Chinese medicine believes that this disease is due to the evil of fire poison, traumatic flesh; even the heat evil into the inside, fire poisoning heart attack, gas consumption yin, block the veins, and the phenomenon of qi and yin.
TCM syndrome differentiation: lighter generally does not need oral administration of decoction, only local treatment can be, severe cases can be treated according to the following types:
1, toxic heat blazing (early)
Main card: skin edema, erythema, blisters, erosion, high fever, lazy words, loss of appetite, red tongue, pulse number.
Dialectical: toxic heat is flaming, fire poisoning internal attack.
2, hot Sheng Yin type (medium)
Main card: localized facial flushing, edema, blisters and a large amount of exudation, conscious burning, fever, irritability, thirst, less urine, red tongue, pulse number or fine number.
Dialectical: hot and yin, wet poison is not exhausted.
3, qi and blood deficiency type (late)
Main card: sore granulation tissue is not fresh, flesh growth is slow, lack of appetite, loss of appetite, or with low fever, pale red tongue, weak pulse.
Dialectical: long-term disease loss, qi and blood loss.
Examine
Burn inspection
The diagnosis can be confirmed by a consultation.
I degree burn injury is the lightest: burn skin redness, pain, obvious tenderness, exudation or edema, local whitening when the injured part is lightly pressed, but no blisters.
II degree burn injury is deep: skin blisters, the bottom of the blisters are red or white, full of clear, viscous liquid. Sensitive to tenderness, whitening when oppressed.
The third degree burn injury is the deepest: the burn surface can be white, soft or black, charred leather. Since the burnt skin becomes pale, it is often mistaken for normal skin in white-skinned people, but it does not change color when pressed. Destroyed red blood cells can make the skin of the burn appear bright red, occasionally blisters, and the hair in the burned area is easily pulled out and the feeling is reduced.
Diagnosis
Diagnosis of burn diagnosis
diagnosis
Diagnosis can be made based on medical history, clinical manifestations, and examination.
Differential diagnosis
Combined with the medical history, the diagnosis can be confirmed without identification with other diseases. Mainly and such as water and salt electrolyte disorders, acid-base balance disorders, shock, DIC, immune imbalance, secondary infection, cardiac insufficiency, respiratory insufficiency, etc., especially the differential diagnosis of respiratory function. Also distinguish from skin rash skin injury, pay attention to observe the color of the skin and the differential diagnosis of the symptoms, active symptomatic treatment.
